Eczema

Medically Reviewed on 12/7/2023

What is eczema?

Atopic Dermatitis or Eczema
Atopic dermatitis is the most common type of eczema.

Eczema is an inflammatory condition of the skin where patches of skin become rough and inflamed, often producing tiny fluid-filled bumps that can leak clear fluid. It can occur at any age and is often chronic. The condition tends to worsen and then subside periodically.

Rather than a specific health condition, eczema is a reaction pattern that the skin produces in several diseases. It begins as red, raised tiny blisters containing a clear fluid atop red, elevated plaques. When the blisters break, the affected skin will weep and ooze. In older and chronic eczema, the blisters are less prominent and the skin is thickened, elevated, and scaling.

What are the types and causes of eczema?

There are at least 11 distinct types of skin conditions that produce eczema. To develop a treatment plan, it is important to distinguish them. This is often not easy.

The 11 types of skin conditions that cause eczema include:

  1. Atopic dermatitis: This health condition has a genetic basis and produces a common type of eczema. Atopic dermatitis tends to begin early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles.
  2. Irritant dermatitis: This occurs when the skin is repeatedly exposed to excessive washing or toxic substances.
  3. Allergic contact dermatitis: After repeated exposures to the same substance, an allergen, the body's immune recognition system, becomes activated at the site of the next exposure and produces dermatitis. An example of this would be poison ivy allergy.
  4. Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs.
  5. Fungal infections: This can produce a pattern identical to many other types of eczema, but the fungus can be visualized by scraping under the microscope or grown in culture.
  6. Scabies: It's caused by an infestation by the human itch mite and may produce a rash very similar to other forms of eczema.
  7. Pompholyx (dyshidrotic eczema): This is a common but poorly understood health condition that classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles.
  8. Lichen simplex chronicus: It produces thickened plaques of skin commonly found on the shins and neck.
  9. Nummular eczema: This is a nonspecific term for coin-shaped plaques of scaling skin most often on the lower legs of older individuals.
  10. Xerotic (dry skin) eczema: The skin will crack and ooze if dryness becomes excessive.
  11. Seborrheic dermatitis: It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, it can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.

What triggers eczema flare-ups?

The exact cause of eczema is unknown. It occurs due to an overactive immune system that responds aggressively when exposed to triggers. Certain conditions such as asthma are seen in many patients with eczema. There are different types of eczema, and they tend to have different triggers.

Common triggers of eczema flare-ups include:

  • Skin contact with chemical irritants, for example, soaps and detergents
  • Certain fabrics such as rough fabrics
  • Synthetic fabrics
  • Increased body temperature
  • Sweating
  • Temperature changes
  • Stress
  • Food allergies
  • Animal fur
  • Upper respiratory infections and other systemic infections
  • Asthma

What are the symptoms of eczema?

Eczema
Eczema characteristically causes itching and burning of the skin.

Almost all patients with eczema complain of itching. The appearance of most types of eczema is similar (elevated plaques of red, bumpy skin); however, the distribution of the eruption can be of great help in distinguishing one type from another. For example, stasis dermatitis occurs most often on the lower leg while atopic dermatitis occurs in the front of the elbow and behind the knee.

Common symptoms of eczema include:

  • Intense itching
  • Red or brownish-gray patches
  • Multiple small, raised bumps that may ooze fluid when scratched
  • Crusting due to dried-up fluid
  • Pus discharge due to secondary infection
  • Thick skin
  • Dry, scaly, cracked skin
  • Worsening of eczema following scratching

Is eczema contagious? How does it spread?

Eczema caused by fungi and scabies is transmissible to others. None of the other types of eczema are contagious.

While eczema does not spread from person to person, it can spread to various parts of the body (for example, the face, cheeks, and chin [of infants] and the neck, wrist, knees, and elbows [of adults]). Scratching the skin can make eczema worse.

When should you see a doctor for your eczema?

If you've never had an eczema flare-up before, you should go to the doctor to be properly diagnosed. Many other conditions such as psoriasis look like eczema and have similar symptoms.

It's also important to make an appointment with your doctor if your eczema gets worse and nothing seems to help tame your symptoms. Don't rely solely on vitamins and nutrition to treat an eczema flare. It's unlikely they will fix an immediate problem.

IMAGES

Eczema See pictures of allergic skin disorders such as eczema, contact dermatitis and more caused by allergies See Images

What specialists treat eczema?

Eczema often is treated by family physicians, but since there are many causes of eczema, it may be necessary to seek help from a health specialist if things are not improving. Most dermatologists (physicians who specialize in skin disorders) specialize in the diagnosis and treatment of all forms of eczema.

How do healthcare professionals diagnose eczema?

An accurate diagnosis requires an examination of the entire skin surface and a careful health history. A doctor needs to rule out curable conditions caused by infectious organisms. Occasionally, a sample of skin (biopsy) may be sent for examination in a laboratory.

What is the treatment for eczema?

Eczema may be persistent and difficult to treat. A combination of various treatment modalities may be required to treat eczema and control flare-ups. Despite successful treatment, flare-ups may still occur. Treatment of eczema also involves identifying and avoiding skin irritants or food allergies, avoiding extreme temperatures, and frequently lubricating the skin.

Treatment options for eczema include the following:

Topical medications

Topical medications are medications that are applied externally, over the skin. This includes medicated creams, ointments, and lotions. They are used to reduce swelling, dryness, and itching and help heal the skin. Topical medications that are commonly prescribed for eczema contain corticosteroids. Steroids reduce inflammation and itching, but overuse can cause thinning of the skin.

  • Other creams contain drugs such as tacrolimus (Protopic) that suppress white blood cells and hence control skin reactions. Direct strong sunlight should be avoided when these products are being used.
  • Topical antibiotics may be prescribed to treat secondary (superimposed) infections.
  • Regularly applying moisturizers free of chemicals, artificial colors, or fragrances will help soothe the skin, hydrate, repair, and soften it as well.

Oral medication

  • Medication to treat an infection: Antibiotics may be prescribed to treat secondary infections. Antibiotic creams may also be used. An antibacterial cream may be used if your skin has a bacterial infection, an open sore, or cracks. The doctor may recommend oral antibiotics for a short time to treat the infection.
  • Medication to reduce inflammation: Oral corticosteroids such as prednisone may be prescribed in severe cases and cases in which there is no improvement with only topical medication. Steroids suppress the immune system and hence suppress inflammation and skin reactions.
  • Newer medications to treat severe eczema: Injectable medicines such as dupilumab (Dupixent) may be used in severe cases of eczema. These medications modify the immune system, reducing inflammation and the signs and symptoms associated with eczema.

Other therapies

  • Wet dressings: Wrapping the affected area with topical medications and wet bandages can help in severe and widespread eczema. This may be done by a healthcare professional or at home after learning the instructions.
  • Phototherapy (light therapy): Light therapy can be used in cases when topical treatments don't help and in those who have frequent flare-ups. Light therapy involves exposing the skin to controlled amounts of natural sunlight or artificial ultraviolet A (UVA) and ultraviolet B (UVB).
  • Psychological counseling: A professional therapist or counselor can help you deal with frustration and depression due to your skin condition. Stress can induce flare-ups and a therapist can help you learn to manage stress. Relaxation techniques can help those who have a habit of constantly scratching.

What home remedies help relieve eczema symptoms?

A significant part of eczema treatment is caring for the skin at home and avoiding allergens and triggers. It is important to establish a regular bathing and moisturizing routine to maintain skin health.

To manage your eczema at home, you can do the following:

  • Bathe in lukewarm water.
  • Use a gentle, unscented, fragrance-free cleanser.
  • Gently pat the skin dry without rubbing.
  • Apply any topical medications to the area.
  • Apply a liberal amount of moisturizer all over your body within 3 minutes of your shower.
  • Apply a dressing or wet wrap.
  • Avoid scratching the skin.
  • Avoid harsh soaps, lotions, or detergents.

You may find that a bath soothes the skin. Some bath treatments that might help include soaking in a full tub of lukewarm water with one of the following:

  • ¼ cup of baking soda to relieve itching
  • ½ cup of regular bleach to help with skin infections
  • 1 cup table salt to relieve stinging

Managing stress is also an important piece of your eczema treatment.

Alternative therapies

Some complementary therapies may also help eczema:

Which vitamins and supplements can help treat eczema?

Eczema treatment is difficult to standardize because researchers have not found one underlying cause for this condition. Steroid creams and tablets are often used as first-line eczema remedies.

It's not safe to take steroids indefinitely or use them on your skin for long periods. They can thin the skin, cause uncomfortable withdrawal effects, and might even alter the appearance of your skin over time. This leads to many people trying nonprescription vitamins and supplements for eczema in hopes of finding relief.

Some over-the-counter supplements, oils, and serums for this condition are touted as miraculous, but unfortunately, they don't deliver on this claim.

Here are options that have shown promise in recent research:

Fish oil

High-quality fish oil is often touted as a magic pill that improves the health of the skin, hair, and heart. There is little research regarding its use for eczema, but the results of the studies that do exist are promising. Fish oil supplements that contain both omega-3 and omega-6 fatty acids might help reduce eczema symptoms.

Probiotics

When people talk about probiotics, they might mean the live bacterial cultures found in yogurt, miso, and sauerkraut. They also might be referring to probiotic supplements. Using more than one strain of probiotics at a time, and using probiotics and prebiotics (plant fiber that “feeds” probiotic bacteria) together, has been shown in studies to help with eczema symptoms.

A clinical trial in 2020 showed that applying a specific strain of probiotics (Roseomonas mucosa) to a patient's skin may help treat eczema. This helpful bacterium is present on the surface of human skin, and it might help a person with eczema restore their microbiome.

Vitamin B12

Many vitamins don't make a difference for eczema when taken alone but if you have a vitamin deficiency that affects your skin, your situation might be different. Vitamin B12 cream, when applied topically to eczema spots, might help some people.

Though researchers have not fully explored the role of vitamin B12 in the treatment of eczema, some studies suggest that checking B12 blood levels may benefit some people with this condition.

Vitamin D

Many doctors recommend their patients take vitamin D to decrease inflammation and improve their immune system overall. While there's debate over whether vitamin D supplementation can put eczema into remission, several studies suggest that it can help certain groups of people, especially if their vitamin D levels are too low, to begin with.

Vitamin D might also help eczema patients who live in places that don't get a lot of sunlight during certain times of the year. However, there needs to be more research on this subject before doctors begin prescribing vitamin D as a treatment for eczema.

What is the prognosis of eczema?

Most patients with eczema do quite well under the care of a dermatologist who has made an accurate diagnosis.

Occasionally, eczema can become infected by microorganisms, such as staphylococci or herpes simplex virus. This is because the normal barrier function of the skin has been damaged by the inflammatory condition. In this situation, the infection could be contagious and require antibiotics treatment. An important signal would be the development of fever and pustules, plus pain at the site of the rash.

Is there a cure for eczema?

Each type of eczema requires a specific sort of therapy. The easiest eczemas to cure permanently are those caused by fungi and scabies. Allergic contact eczema can be cured if a specific allergenic substance can be identified and avoided.

What are the complications of eczema?

You can treat and manage your eczema, but you may encounter some complications, such as:

  • Skin infections
  • Pain
  • Eyelid dermatitis
  • Cataracts
  • Stress
  • Emotional distress

What are the possible side effects of eczema treatment?

The immunosuppressants you may use to treat your eczema can have potential side effects, such as:

Is it possible to prevent eczema?

The judicious use of moisturizing creams or ointments can be an effective treatment for many people in preventing certain types of eczema.

What lifestyle changes can help prevent eczema flare-ups?

Lifestyle changes that may help prevent and avoid eczema flare-ups include:

  • Wear cotton-lined gloves when using cleaning products.
  • Avoid using air fresheners, perfume, essential oils, or scented candles.
  • Stay away from all kinds of smoke, particularly tobacco smoke.
  • Avoid bathing in hot water, which can be too harsh and dry for your skin.
  • After a shower, gently pat your skin dry and avoid rubbing.
  • Apply a moisturizing lotion all over your body to lock in moisture after a shower.
  • Avoid direct sunlight exposure.
  • Wear sunscreen when outdoors.
  • Wear loose, breathable cotton clothes and stay away from fabrics such as wool, mohair, polyester, nylon, and rayon.
  • Wash clothes before you wear them to get rid of dyes or chemicals.
  • If you dry-clean your clothes, air them out for 24 hours, as the chemicals can trigger skin rashes.
  • Use gentle detergents and soaps and read the labels to check if the ingredients are skin-friendly, fragrance-free, and suitable for sensitive skin.
  • Reduce stress with relaxation techniques such as yoga, meditation, deep breathing, or biofeedback. Anxiety and stress can make eczema worse by inducing inflammation.
  • Vacuum your house regularly if you are allergic to dust, pollen, pet dander, or dust mites.
  • During and after a workout, stay hydrated and try to avoid overheating.

What foods should I avoid to prevent eczema outbreaks?

The role of diet in atopic dermatitis is controversial. There is little compelling evidence that diet plays a significant role in causing or preventing outbreaks in the majority of people who have eczema, no matter which type they have.

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Medically Reviewed on 12/7/2023
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